Phillips William, Piller Linda B, Williamson Jeff D, Whittle Jeffrey, Jafri Syed Z A, Ford Charles E, Einhorn Paula T, Oparil Suzanne, Furberg Curt D, Grimm Richard H, Alderman Michael H, Davis Barry R, Probstfield Jeffrey L
University of California Davis, Davis, CA.
J Clin Hypertens (Greenwich). 2013 Nov;15(11):825-32. doi: 10.1111/jch.12180. Epub 2013 Aug 7.
Calcium channel blockers (CCBs) are an important class of medication useful in the treatment of hypertension. Several observational studies have suggested an association between CCB therapy and gastrointestinal (GI) hemorrhage. Using administrative databases, the authors re-examined in a post-hoc analysis whether the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants randomized to the CCB amlodipine had a greater risk of hospitalized GI bleeding (a prespecified outcome) compared with those randomized to the diuretic chlorthalidone or the angiotensin-converting enzyme inhibitor lisinopril. Participants randomized to chlorthalidone did not have a reduced risk for GI bleeding hospitalizations compared with participants randomized to amlodipine (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.92-1.28). Those randomized to lisinopril were at increased risk of GI bleeding compared with those randomized to chlorthalidone (HR, 1.16; 95% CI, 1.00-1.36). In a post-hoc comparison, participants assigned to lisinopril therapy had a higher risk of hospitalized GI hemorrhage (HR, 1.27; 95% CI, 1.06-1.51) vs those assigned to amlodipine. In-study use of atenolol prior to first GI hemorrhage was related to a lower incidence of GI bleeding (HR, 0.69; 95% CI, 0.57-0.83). Hypertensive patients on amlodipine do not have an increased risk of GI bleeding hospitalizations compared with those taking either chlorthalidone or lisinopril.
钙通道阻滞剂（CCB）是一类重要的用于治疗高血压的药物。多项观察性研究表明CCB治疗与胃肠道（GI）出血之间存在关联。作者利用管理数据库，在一项事后分析中重新审视了与随机接受利尿剂氢氯噻嗪或血管紧张素转换酶抑制剂赖诺普利治疗的患者相比，随机接受CCB氨氯地平治疗的高血压预防心脏病发作试验（ALLHAT）参与者发生住院胃肠道出血（一个预先设定的结果）的风险是否更高。与随机接受氨氯地平治疗的参与者相比，随机接受氢氯噻嗪治疗的参与者发生胃肠道出血住院的风险并未降低（风险比[HR]，1.09；95%置信区间[CI]，0.92 - 1.28）。与随机接受氢氯噻嗪治疗的参与者相比，随机接受赖诺普利治疗的参与者发生胃肠道出血的风险增加（HR，1.1 ...展开 6；95% CI，1.00 - 1.36）。在一项事后比较中，与接受氨氯地平治疗的参与者相比，接受赖诺普利治疗的参与者发生住院胃肠道出血的风险更高（HR，1.27；95% CI，1.06 - 1.51）。首次胃肠道出血前在研究中使用阿替洛尔与胃肠道出血发生率较低相关（HR，0.69；95% CI，0.57 - 0.83）。与服用氢氯噻嗪或赖诺普利的患者相比，服用氨氯地平的高血压患者发生胃肠道出血住院的风险并未增加。
